Form V (See Rule 8) APPLICATION FOR NEW LICENSE/RENEWAL ...
Form V (See Rule 8) APPLICATION FOR NEW LICENSE/RENEWAL ...
Form V (See Rule 8) APPLICATION FOR NEW LICENSE/RENEWAL ...
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1<br />
<strong>Form</strong> V<br />
(<strong>See</strong> <strong>Rule</strong> 8)<br />
<strong>APPLICATION</strong> <strong>FOR</strong> <strong>NEW</strong> <strong>LICENSE</strong>/RE<strong>NEW</strong>AL OF <strong>LICENSE</strong> TO<br />
ENGAGE IN THE BUSINESS OF PRIVATE SECURITY AGENCY<br />
To,<br />
The Controlling Authority &,<br />
Jt. Commissioner of Police (Admn.),<br />
Mumbai<br />
The undersigned hereby applies for obtaining a license to run the business of<br />
operating services in the area of Private Security Agencies.<br />
1. Full name of the applicant : _______________________________________<br />
2. Son / Wife / Daughter of : _______________________________________<br />
3. Nationality of the applicant : _______________________________________<br />
4. Residential Address : _______________________________________<br />
_______________________________________<br />
_______________________________________<br />
5. Address, where the applicant : _______________________________________<br />
desires to start his agency. _______________________________________<br />
6. Name of the Private Security<br />
agency<br />
7. Name(s) and address of<br />
Proprietor, Partners, Majority<br />
Shareholder, Director and<br />
Chairman of the Agency<br />
8. Name and extent of facilities<br />
available<br />
9. Qualification of staff engaged<br />
for imparting instructions.<br />
: _______________________________________<br />
_______________________________________<br />
: _______________________________________<br />
_______________________________________<br />
_______________________________________<br />
: _______________________________________<br />
: _______________________________________<br />
Name : _______________________________________<br />
Age: ____________ Designation: ________________________<br />
Qualification : _____________<br />
10. Equipments which will be used for security services. :<br />
a) Door Framed Metal Detector (DFMD)
) Hand Held Metal Detector (HHMD)<br />
c) Mine Detector<br />
d) Other Detectors<br />
i) Wireless Telephones<br />
ii) Alarm Devises<br />
iii) Armored Vehicles.<br />
iv) Arms<br />
v) Others (please specify)<br />
2<br />
11. The particulars of the uniform including colour in case the applicant intends to use<br />
any uniform for the Private Security Guards and Supervisors of the Agency.<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
12. Does the applicant intent to operate in more than one district? If so the name of the<br />
Districts. 1. ____________, 2. ____________, 3. ____________, 4. ____________,<br />
5. ____________,<br />
13. Does the applicant intend to operate in the entire state ? YES / NO.<br />
14. Does the applicant possess training facility of its own or will get it on outsourcing basis ?<br />
Name and address of training facility should be furnished.<br />
Signature : ____________________________<br />
Name of the applicant : ____________________________________________<br />
Address of the application : ____________________________________________<br />
Telephone number of the applicant : (O)___________, (R)___________, (M)__________<br />
Date of application. :<br />
Enclosure :<br />
1. Copy of current Income Tax Clearance Certificate.<br />
2. Affidavit as prescribed in Section 7 sub-section (2) of the Act.<br />
3. Other enclosures (As asked for)
3<br />
List of documents to be enclosed with an application for license under<br />
the Private Security Agencies (Regulation) Act-2005 and as laid down under<br />
the Maharashtra Private Security Agencies (Regulation) <strong>Rule</strong>s-2007<br />
1. Deed of partnership/proprietorship etc. which has names, addresses etc. of all those responsible for the<br />
running of the company / agency,<br />
2. affidavit in original of Rs. 100/ stamp paper incorporating the details in relation to the provisions contained in<br />
Sec. 6., Sec. 9 and Sec. 11 of the Private Security Agencies (Regulation) Act-2005,<br />
3. Copy of gazette regarding registration of the agency with Guards Board,<br />
4. Copy of notification issued by Department of Industry, Energy, Labour, Govt. of Maharashtra,<br />
5. Certificate of registration under Maharashtra State Tax on Profession, Trades, Callings and Employments<br />
Act-1975,<br />
6. Registration under Employees State Insurance Act-1948,<br />
7. Registration under Sec. 69 of the Finance Act-1994,<br />
8. Registration with the office of Regional Provident Fund Commissioner,<br />
9. Registration with the office of Central Labour Commissioner, Govt. of India,<br />
10. License granted by Govt. of India, Ministry of Labour under contract Labour (Regulation & Abolition) Act -<br />
1970,<br />
11. Registration of the establishment under Bombay Shops and Establishment Act-1948.<br />
12. Details of contracts/places where the applicant has supplied security guards including armoured vehicles with<br />
details of guards provided at each of the places,<br />
13. Details of all employees of the applicant company giving details as mentioned below :<br />
Sr.<br />
No.<br />
Name and<br />
address of the<br />
employee<br />
Nationality<br />
of the<br />
employee<br />
Date of<br />
birth of<br />
the<br />
employee<br />
Training, if<br />
any,<br />
undergone<br />
by the<br />
employee<br />
Details of the<br />
employee if exarmed<br />
forces,<br />
police or Home<br />
guards<br />
Reason for<br />
leaving the<br />
previous service<br />
(Ref. col. No. 6)<br />
1 2 3 4 5 6 7<br />
14. Character verification certificates of all employees (Manager to security guards) of the applicant as done by<br />
'G' Branch, SB (I) CID and as required under the Maharashtra Private Security Guards (Regulation of<br />
Employment and Welfare) Act-1981, (Application to be made in <strong>Form</strong>-II of the Maharashtra Private Security<br />
Agencies (Regulation) <strong>Rule</strong>s-2007.<br />
15. Details of Arms licenses granted to the applicant agency, its proprietor/partner/director etc, and details of<br />
arms licenses with the employees of the applicant agency, either in Mumbai or any place in India,<br />
16. Four coloured photographs (from all angles), post card size showing details of uniform from all 4 sides used<br />
by the staff of the security agency, including cap and badges,<br />
16. <strong>Form</strong>at/ copy of photo identity card issued to the employees of the applicant as required in <strong>Form</strong>-IX of the<br />
Maharashtra Private Security Agencies (Regulation) <strong>Rule</strong>s-2007,<br />
17. <strong>Form</strong>-I {<strong>Rule</strong>-3 of the Maharashtra Private Security Agencies (Regulation) <strong>Rule</strong>s-2007} for verification of<br />
antecedents of every parter/director of the applicant firm enclosing therewith a draft of Rs. 200/- per<br />
applicant.<br />
18. Separate Character Verification Report (to be issued by the applicant company) in respect of each or all of<br />
the employees of the applicant company confirming that they have no criminal record against them (<strong>Form</strong> III)<br />
* All documents to be duly attested by a notary public.<br />
.
4<br />
MAH. PVT. SECURITY AGENCIES REGULATIONS RULES, 2007<br />
<strong>FOR</strong>M II<br />
(<strong>See</strong> rule 4)<br />
<strong>Form</strong> for verification of character and antecedents of Security Guard and supervisor<br />
Thumb Impression * of the Applicant :<br />
Signature of the Applicant :<br />
For official use only<br />
<strong>Form</strong> number<br />
Name of the police station sent for<br />
police verification<br />
Fee Amount Rs D.D/Pay Order No.<br />
Name of Bank Date of Issue<br />
Please read the instructions carefully before filling the form, Please fill in BLOCK<br />
LETTERS : (CAUTION : Please furnish correct information. Furnishing of incorrect<br />
information or surppression of any factual information in the form will render the<br />
candidate unsuitable for employment/engagement in the Private Agency.)<br />
1. Name of applicant as should appear in the photo-identity card<br />
Last name __________ First Name __________ Middle Name __________<br />
2. If you have ever changed your name, please indicate the previous name(s) in full<br />
__________________________________________________________________________________<br />
3. Sex (male /female) 4. Date of Birth<br />
5. Place of Birth : Village / Town ______________________, District<br />
6. Father's Full Name/Legal Guardian's Full Name (including Surname, if any).<br />
__________________________________________________________________________________<br />
7. Mother's Full Name (including surname, if any) :<br />
__________________________________________________________________________________<br />
8. If married, Full Name of Spouse (including surname, if any) :<br />
__________________________________________________________________________________<br />
9. Present Residential Address, including Street No. / Police station, village and District (with PIN code)<br />
__________________________________________________________________________________<br />
Telephone No. / Mobile No. _____________________________________________________<br />
10. Please give the date since residing at the above-mentioned address : (DD/MM/YYYY)<br />
___________________________________________________________________________________<br />
11. Permanent Address, including Street No. / police station, village and District (with PIN code )<br />
___________________________________________________________________________________<br />
12. If you have not resided at the address given at Column (9) continuously for the last five years,<br />
please furnish the other address (addresses) with duration (s) resided. You should furnish<br />
additional photocopies of this form for each additional place of stay during, the last five years,<br />
forms may be photocopied but photograph and signature in original are required on each form.<br />
Sr.<br />
No.<br />
From To Address including Street No., Police Station, Village and<br />
District (with PIN code)<br />
Date
Sr.<br />
No.<br />
5<br />
MAH. PVT. SECURITY AGENCIES REGULATIONS RULES, 2007<br />
From To Address including Street No., Police Station, Village and<br />
District (with PIN code)<br />
13. In case of stay abroad, particulars of all places where you have resided for more than one year after<br />
attaining the age of twenty one years :<br />
___________________________________________________________________________________<br />
14. Other Details<br />
(a) Educational Qualifications :<br />
(b) Previous positions held, if any, alongwith name and address of employers :<br />
(c) Reason for leaving last employment:<br />
(d) Visible Distinguishing Mark :<br />
15. Did you earlier operated any Private Security Agengy or were its partner, majority shareholder of<br />
Director ? If yes then furnish the name, address of the Agency and its license particulars<br />
___________________________________________________________________________________<br />
___________________________________________________________________________________<br />
16. Are you a citizen of India by : Birth / Descent / Registration / Naturalisation : If you have ever<br />
possessed any other citizenship, please indicate previous citizenship : __________________________<br />
___________________________________________________________________________________<br />
17. Have you at any time been convicted by a court in India for any criminal offence and sentenced to<br />
imprisonment ? If so, give name of the court, case number and offence (Attach copy of judgment)<br />
___________________________________________________________________________________<br />
18. Are any criminal proceedings pending against you before a court in India ? If so, give name of court,<br />
case number and offence ______________________________________________________________<br />
__________________________________________________________________________________<br />
19. Self-Declaration<br />
The information given by me in this form and enclosures in true and I am solely responsible for accuracy.<br />
Date :<br />
Place : (Signature / T.I.* of applicant)<br />
20. Enclosures<br />
___________________________________________________________________________________<br />
___________________________________________________________________________________<br />
(Signature / T.I.* of applicant)<br />
(*Left Hand Thumb Impression if Male and Right Hand Impression if Female)<br />
<strong>FOR</strong> OFFICE USE ONLY<br />
File No.<br />
___________________________________________<br />
Date of Issue of C and A Report<br />
___________________________________________<br />
(Signature of Police Station In Charge) ___________________________________________<br />
Name of Police Station<br />
___________________________________________<br />
Name of Police District.<br />
___________________________________________<br />
* N.B.-Cancel whatever is not applicable.<br />
---------
6<br />
MAH. PVT. SECURITY AGENCIES REGULATIONS RULES, 2007<br />
<strong>FOR</strong>M III<br />
(<strong>See</strong> rule 4)<br />
Character and Antecedent Cerificate<br />
This is to certify that Mr./Ms. _________________________________________________<br />
Son /Daughter of ____________________________________________ whose particulars<br />
are given below has good moral character and reputation and that the applicant has been<br />
staying at following address continuously for the last one year.<br />
Date of Birth : _____________________________________<br />
Place of Birth : _____________________________________<br />
Educational Qualification : _____________________________________<br />
Profession : _____________________________________<br />
Present Address : _____________________________________<br />
Issuing Authority : _____________________________________<br />
Signature :<br />
_____________________________________<br />
Name : _____________________________________<br />
Designation : _____________________________________<br />
Address : _____________________________________<br />
Tel. No. : _____________________________________<br />
Date of Issue : _____________________________________<br />
Sign & Seal of<br />
Owner/Director/Partner of<br />
Security Agency